Influence of molecular classification in anaplastic glioma for determining outcome and future approach to management

Back, Michael; Jayamanne, Dasantha; Brazier, David; Newey, Alison; Bailey, Dale L.; Schembri, Geoffrey; Hsiao, Edward; Khasraw, Mustafa; Wong, Matthew; Kastelan, Marina; Guo, Linxin; Clarke, Stephen; Wheeler, Helen

doi:10.1111/1754-9485.12850

Cited by 7 publications

(4 citation statements)

References 40 publications

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“…There is a big survival difference between IDH1-mutated vs. wild-type gliomas. Although IDH1 mutant glioblastoma has still significantly worse outcomes than grade II and III gliomas, there are no differences in survival between IDH mutant grades II and III [40]. For this reason, Shirahata et al proposed a novel, improved grading system for IDH-mutant astrocytic gliomas [41].…”

Section: Radiomic Data For the Genetic And Molecular Features Of Lggsmentioning

confidence: 99%

Advanced imaging in adult diffusely infiltrating low-grade gliomas

Bulakbaşı¹,

Paksoy

2019

Insights Imaging

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The adult diffusely infiltrating low-grade gliomas (LGGs) are typically IDH mutant and slow-growing gliomas having moderately increased cellularity generally without mitosis, necrosis, and microvascular proliferation. Supra-total resection of LGG significantly increases the overall survival by delaying malignant transformation compared with a simple debulking so accurate MR diagnosis is crucial for treatment planning. Data from meta-analysis support the addition of diffusion and perfusion-weighted MR imaging and MR spectroscopy in the diagnosis of suspected LGG. Typically, LGG has lower cellularity (ADCmin), angiogenesis (rCBVmax), capillary permeability (Ktrans), and mitotic activity (Cho/Cr ratio) compared to high-grade glioma. The identification of 2-hydroxyglutarate by MR spectroscopy can reflect the IDH status of the tumor. The initial low ADCmin, high rCBVmax, and Ktrans values are consistent with the poor prognosis. The gradual increase in intratumoral Cho/Cr ratio and rCBVmax values are well correlated with tumor progression. Besides MR-based technical artifacts, which are minimized by the voxel-based assessment of data obtained by histogram analysis, the problems derived from the diversity and the analysis of imaging data should be solved by using artificial intelligence techniques. The quantitative multiparametric MR imaging of LGG can either improve the diagnostic accuracy of their differential diagnosis or assess their prognosis.

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Section: Radiomic Data For the Genetic And Molecular Features Of Lggsmentioning

confidence: 99%

Advanced imaging in adult diffusely infiltrating low-grade gliomas

Bulakbaşı¹,

Paksoy

2019

Insights Imaging

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“…Whilst this study is limited in description of late effects of IMRT, the functional endpoints of excellent performance status and sustained employment suggest that in the median follow-up period of survivors the impact of IMRT is acceptable. This has also been demonstrated in a larger cohort from multiple brain regional sites where functional status in the years post IMRT is high, and most latent impact arises from the immediate postoperative morbidity [13,[30][31][32].…”

Section: Discussionmentioning

confidence: 67%

Large Tumour Volume Reduction of Idh Mutated Anaplastic Glioma Involving the Insular Region Following Radiation Therapy: an Alternative to Maximal Surgical Resection

Metz¹,

Wong²,

Jayamanne³

et al. 2021

Preprint

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Background: In IDH-mutated anaplastic glioma (IDHmutAG) of the insular cortex there remains uncertainty of benefit with near-total resection compared to limited surgery with radiation therapy (IMRT). This study aimed to assess tumour volume reduction in patients following IMRT and impact of residual post-surgical volume. Methods and Materials:Patients with IDHmutAG involving insular cortex managed with IMRT from 2008-2019 had baseline patient, tumour and treatment factors recorded. Volumetric assessment of residual disease on MRI was performed at baseline, month+3 and month+12 post-IMRT. Potential prognostic factors were analysed for tumour reduction and relapse-free survival, and assessed by log-rank and Cox regression analyses. Results: 32 patients with IDHmutAG of the insular cortex were managed with median follow-up post-IMRT of 67.2 months. Pathology was anaplastic astrocytoma (AAmut) in 20, and anaplastic oligodendroglioma (AOD) in 12 patients. Median pre-IMRT volume on T1 and T2Flair was 24.3cm3 and 52.2cm3. Twenty-seven patients were alive with 5-year relapse-free survival of 80%. There was a median 67% and 64% reduction from baseline occurring at 3 months post-IMRT for T1 and T2Flair respectively; and subsequent median 78% and 73% at 12 months. At 12 months AOD patients had median 83% T1 volume reduction compared to 63% in AAmut (p<0.01). There was no difference on T2Flair volume (p=0.64). No other pathological factors influenced volume reduction at 12 months. No factors were associated with relapse-free survival including baseline T1 (p=0.52) and T2Flair (p=0.93) volume.Conclusion:IMRT provides large tumour volume reduction in IDHmutAG of the insular cortex with no significant negative impact of residual disease volume on relapse-free survival.

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“…As knowledge of IDH mutated glioma expands then the potential to predict more adverse tumour subsites may infer a need for a more aggressive initial approach aimed at near-total resection. An expanding knowledge of molecular features, such as CDKN2A heterogenous deletion [ 35 , 36 ], may then become factors that influence the utilisation of a more aggressive approach with repeat craniotomy seeking maximal tumour reduction prior to delivery of IMRT.…”

Section: Discussionmentioning

confidence: 99%

Large tumour volume reduction of IDH-mutated anaplastic glioma involving the insular region following radiotherapy

et al. 2022

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Background The impact of near-total resection of IDH-mutated anaplastic glioma (IDHmutAG) is well-established but there remains uncertainty of benefit in tumours of the insular cortex where the extent of safe resection may be limited. This study aimed to assess tumour volume reduction in patients following IMRT and impact of residual post-surgical volume. Methods and materials Patients with IDHmutAG involving insular cortex managed with IMRT from 2008 to 2019 had baseline patient, tumour and treatment factors recorded. Volumetric assessment of residual disease on MRI was performed at baseline, month+ 3 and month+ 12 post-IMRT. Potential prognostic factors were analysed for tumour reduction and relapse-free survival, and assessed by log-rank and Cox regression analyses. Results Thirty two patients with IDHmutAG of the insular cortex were managed with median follow-up post-IMRT of 67.2 months. Pathology was anaplastic astrocytoma (AAmut) in 20, and anaplastic oligodendroglioma (AOD) in 12 patients. Median pre-IMRT volume on T1 and T2Flair was 24.3cm3 and 52.2cm3. Twenty-seven patients were alive with 5-year relapse-free survival of 80%. There was a median 67 and 64% reduction from baseline occurring at 3 months post-IMRT for T1 and T2Flair respectively; and subsequent median 78 and 73% at 12 months. At 12 months AOD patients had median 83% T1 volume reduction compared to 63% in AAmut (p < 0.01). There was no difference on T2Flair volume (p = 0.64). No other pathological factors influenced volume reduction at 12 months. No factors were associated with relapse-free survival including baseline T1 (p = 0.52) and T2Flair (p = 0.93) volume. Conclusion IMRT provides large tumour volume reduction in IDHmutAG of the insular cortex. While maximal safe debulking remains standard of care when feasible, this patient cohort reported no significant negative impact of residual disease volume on relapse-free survival.

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Influence of molecular classification in anaplastic glioma for determining outcome and future approach to management

Cited by 7 publications

References 40 publications

Advanced imaging in adult diffusely infiltrating low-grade gliomas

Advanced imaging in adult diffusely infiltrating low-grade gliomas

Large Tumour Volume Reduction of Idh Mutated Anaplastic Glioma Involving the Insular Region Following Radiation Therapy: an Alternative to Maximal Surgical Resection

Large tumour volume reduction of IDH-mutated anaplastic glioma involving the insular region following radiotherapy

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